Multilevel Postoperative Cervical Epidural Hematoma: Complete Removal Through Catheter Drainage of the Unexposed Blood Collection

Multilevel Cervical Epidural Hematoma After C5-6 Anterior Cervical Discectomy and Fusion: The Cry of a Neurosurgeon

“…One of the interesting radiological findings in our patient was that the thickest part of the EDH was found on the upper cervical spine although the patient’s head was in an elevated position at almost 45 degrees on the bed. We must agree with authors who experienced similar complications that wide decompression and placement of the PEEK cage resulted in hidden and large epidural space in which unnoticed or small injury to the plexus bled and filled the enlarged epidural space [ 3 , 4 , 7 ]. The bleeding did not stop because of the wide epidural space made by surgical decompression and went to the upper cervical levels.…”

“…Cervical anterior EDH is an uncommon complication related to ACDF and is generally confined to the primary surgical site. Anterior bleeding far from the surgical site or multilevel EDH in the cervical spine is very rare with a few cases reported in the literature [3][4][5][6][7]. Several risk factors are well-known by neurosurgeons, among which preoperative coagulopathies and multilevel surgical procedures are considered significant risk factors [8,9].…”

“…The limited data related to multilevel cervical anterior EDH in the current literature focuses on only one explanation, that is, injury to the anterior internal vertebral venous plexus located anterolaterally in the spinal canal [ 11 ]. It has been reported that this plexus can be injured during wide exposure such as the opening of the posterior longitudinal ligament or removal of osteophytes [ 3 , 4 ]. As these veins have no valve, a sudden increase in blood pressure because of coughing or Valsalva maneuver even during extubation can be directly transmitted to these veins, which start bleeding and can result in multilevel anterior EDH.…”

“…The majority of anterior EDHs are generally confined to the surgical site. However, anterior EDH far from the primary surgical site, called multilevel EDH, has been rarely described in a few cases [ 3 , 4 ]. Anterior EDH after ACDF, especially symptomatic ones, can be life-threatening, and prompt surgical intervention is the sine qua non.…”

Delayed postoperative spinal epidural hematoma after anterior cervical discectomy and fusion: A case report

“…If symptoms do not improve, emergency surgery should be performed as soon as possible. During the operation, the hematoma was removed, bleeding was stopped, and a drainage tube was inserted ( 44 ). After the operation, maintain stable anesthesia resuscitation and blood pressure, use a neck brace, and avoid tension and sudden exertion.…”